Table 2.
Demographics, clinical characteristics and treatment of patients with Klebsiella pneumoniae endogenous endophthalmitis (EKE) from case reports.
| Author, Country, Year |
Sex Age |
Underlying Diseases | Serotype | Focus of Infection | Ophthalmic Findings | Associated Septic Spread | General Treatment | Opththalmic Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Seo, R58 Japan, 2016 |
F, 64 |
- | K2A, rmpA positive | KPLA a right lobe | VA b: NLP c Chemosis, corneal, vitreal haze |
thrombocytopenia, coagulopathy |
iv d meropenem (3 g/day), changed to ceftriaxone (2 g/day) percutaneous drainage of KPLA |
Early VIT e | VA: NLP |
| Saccente M18, US, 1999 | M, 38 | diabetes | No info | KPLA right lobe, | VA: 20/400, Hypopyon, chemosis, vitreal haze |
meningitis | iv ceftriaxone (21 days), metronidazole (17 days), followed by oral levofloxacin and metronidazole, 30 days | Intravitreal ceftazidime and vancomycin; Topic ciprofloxacin, cefazolin and corticosteroids 1 drop/1–2 h |
VA: 20/60 |
| Maruno T38, Japan, 2013 | M, 63 |
- | K1 | KPLA right lobe, | VABE: LP f, bilateral endophthalmitis and orbital cellulitis | lungs septic emboli | iv meropenem 1 g/kg every 8 h, changed to ceftriaxone Ultrasound-guided percutaneous transhepatic liver abscess drainage |
No info | Bilateral total vision loss |
| Sobirk S20, Sweden, 2010 | M,45 | - | Mucoid strain | KPLA multiloculated | VA: LP; Chemosis, vitreous hemorrhage | - | iv ceftazidime and vancomycin | Topic antibiotics | Vision loss |
| Baekby M21, Denmark, 2018 | M, 78 | - | K1, hv CC23 clone | multiloculated KPLA > 12 cm | VA: LP, red painful eye | lumbar abscess | iv piperacillin/ tazobactam, followed by oral ciprofloxacin |
Intravitreal ceftazidime and vancomycin | Vision loss |
| Fujita M38, Japan 2015 | F, 70; M, 50 |
- | K1 | KPLA | Case1: VARE: LP; hypopyon, haze of ocular media Case 2: VARE b*: LP; hyperemia, corneal and vitreous haze, |
case 1: iv sulbactam /cefoperazone; percutaneous drainage Case 2: iv clindamycin and cefazolin, then switch to cefepime |
Case 1: VIT + PEA g+ antibiotics Case 2: VIT+ PEA, per secundam IOL h, antibiotics |
Case 1: Corneal melting; evisceration Case 2: preserved partial vision |
|
| Al Mahmood71, Saudi Arabia, 2011 | M, 43; F, 70 |
diabetes | No info | KPLA | Case 1: VA: LP, hemorrhagic purulent vitreous Case 2: VA BE **: LP; ocular hypertension, hypopyon |
iv ceftazidime vancomycin | Case1: vancomycin 1 mg/0.1 mL, ceftazidime 2.25 mg/ 0.1 mL, amphotericin B 10 lg/0.1 mL and dexamethasone 0.4 mg/0.1 mL Case 2: + VIT |
Case 1: VA: NLP Case 2:RE: evisceration; VA LE ***: LP |
|
| Wells JT23, US, 2015 | F, 67 | - | K1 | KPLA | RE: pan ophthalmitis, retinal detachment | peritoneal sepsis, septic shock | iv ceftriaxone, changed to imipenem, vancomycin, and fluconazole | Intravitreal Vancomycin and ceftazidime | deceased |
| Castle G24, UK, 2020 | M, 56 | anti-IFN-3 i autoimmunity | No info | KPLA 9 cm, multiloculated | VARE:1; choroidal abscess VA in LE: HM, marked vitreous and anterior chamber haze |
lung emboli | iv ceftriaxone, followed by oral ciprofloxacin | RE: Vitrectomy, lens removal, intravitreal antibiotics LE: evisceration |
RE: LP, aphakic LE: NLP |
| Paraschiv F25, Romania, 2018 | F, 53 | diabetes | positive string test | KPLA | VA CF Uveitis, retinal hemorrhages |
meningitis thrombocytopenia |
iv vancomycin and ceftriaxone, percutaneous drainage | Intravitreal and topic antibiotics, topic corticosteroids | Partial recovered vision |
| Van Keer J26, Belgium, 2017 | M, 84 | hypertension | No info | KPLA < 30 mm | VARE 20/250; proptosis, chemosis VALE: CF |
- | iv ceftriaxone | Intravitreal ceftazidime, topic antibiotics and cs; LE: vitrectomy | RE: LP LE: partial vision recovery |
| Pichler C5, Germany, 2017 | M, 61 | - | K2 serotype ST2398 | KPLA | endophthalmitis | thrombosis of supra hepatic vein | percutaneous catheter drainage, i.v. piperacillin/tazobactam, and ciprofloxacin | No info | No info |
| Xu 29, China, 2019 | M, 25 | diabetes | KP587, ESBL j | KPLA | VA: LP, hypopyon | i.v. imipenem | Intravitreal imipenem, vancomycin and dexamethasone, VIT | CF k at 0.4 m | |
| Abdul Hamid, A63, UK, 2013 | M, 36 | No info | KPLA, 6 cm, segment VIII | VA: LP, chemosis, sever periorbital edema | tenosynovitis, urinary infection | oral ciprofloxacin, 10 weeks | Intravitreal amikacin 0.4 mg/0.1 mL and vancomycin 1 mg/0.1 mL topic antibiotics, CS, mydriatics |
VA: NLP | |
| Sridhar J65, 2014, US | M,43 F, 58 F,60 |
DM DM Multiple mieloma |
No info | KLPA Spider bite + celullitis unknown |
VA: 2/200 VA:1/200 VA: LP |
no info | no info | Vitreous tap+ Intravitreal vancomycin and ceftazidime − all patients + intravitreal CS − patient 1 + VIT − patient 2 |
Enucleation Evisceration enucleation |
| Hassanin F75, 2021, Saudi Arabia | F, 55 | DM | + string test | Renal abscess | VA: LP, Chemosis, conjunctival injection, hypopion, panopthalmia with orbital cellulitis |
- | iv ceftazidime, vancomycin, and metronidazole | VIT+ intravitreal vancomycin and ceftazidime evisceration |
Anophthalmia |
| Dubey D66, 20313, US | F, 41 | DM | K1, sensitive to carbapemens only | Renal abscess | blurred vision, hypopion, endophthalmitis | lungs, CNS l |
iv meropenem (2 g /8 h), 8 weeks | Intravitreal vancomycin and ceftazidime | No info |
| Martel A76, 2017 | M, 60 | - | KPLA | VA 20/50 Anterior uveitis, subretinal abscess |
urinary | iv ceftazidime | Intravitreal ceftazidime (2.25 mg/0.1 mL), 13 injections | VA 20/20 |
a KPLA: K. pneumoniae liver abscess; b VA: visual acuity, * RE: right eye; ** BE: both eyes; *** LE: left eye; c NLP: no light perception;d iv: intravenous; e VIT: pars plana vitrectomy; f LP: light perception; g PEA: phacoemulsification of the lens; h IOL: intraocular lens; i anti IFN-3: anti-interferon 3; j ESBL: extended spectrum beta lactamase; k CF: counting fingers; l CNS: central nervous system.